German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
Wiesbaden,
12.-16.05.2010.
DÃ¼sseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno115

Outline

Tako tsubo cardiomyopathy (also known as broken heart syndrome) is a rare disorder eludicated just a few years ago, and characterized by cardiac dysfunction caused by endo- or exogenous catecholamines. The symptoms are similar to acute coronary syndrome. We describe two patients who developed Tako tsubo cardiomyopathy during surgery.

A 29 year old healthy female with pleomorphic adenoma was prepared to undergo parotidectomy. After local anesthesia with lidocaine and adrenaline a ventricular tachycardia with hypotension occured. Blood pressure had to be stabilized by catecholamines. Echocardiography showed an ejection fraction of 10% with hypokinesia of the left ventricle. Cardiac dysfunction recovered within a few weeks.

A 38 year old man underwent endonasal sinus surgery but after total intravenous anesthesia had been started severe hypotension occurred. Oxygen saturation was reduced and Troponin I raised up to 11,5 ng/ml (reference <0,5 ng/ml). In echocardiography hypomotility of the interventricular septum and the posterior part of the left ventricle was observed. Coronary heart disease was excluded by coronary angiography. After a few days the patient recovered.

Both cases fulfill the criteria for Tako Tsubo cardiomyopathy with exogenous exposition to adrenaline in the first case and possibly endogenous excess of catecholamines in the second case. ENT surgeons and ENT anesthesists should be aware of this rare disorder that might also occur during surgery.